Kambia and Then Some

I got back yesterday from a four day trip to Kambia, a province north of here-ish. I thought it was a trip to Kambia but it turned out to be a trip to Kambia, Port Loko, Bombali, and Tonkolili. I knew there was going to be a lot of driving but what I had expected wasn't exactly what came to be. There was a bit more than expected.

Monday morning I left the centre with Francis, the driver for the four day screening trip. Along the way we picked up Bernadette, the screening nurse. Both Bernadette and I get car sick so the three of us crammed into the front. I tried throughout the trip to handle the back but with the bumpiness of the roads it was no good. So we got as comfortable as we could, the three of us in the front...

I was surprised how great the roads were once we got out of Freetown. The main roads at least.

I have to admit, the first two days were pretty frustrating. I have heard the statistics... Over 2 million women in Africa afflicted with VVF. I didn't know they would be this difficult to locate. I figured we would just have to walk into a hospital and they would come walking out. Not the case. The first clinic we went to in Kambia had one woman for us to see. She had a gynecological problem, but not VVF. At the clinic they were doing a class for mothers who had children at a young age and were not able to reintegrate back into the school system. They were teaching life skills and how to weave. We had an opportunity to share with them and asked if they knew of any women with VVF. A few people raised their hands. One woman said a prostitute nearby but she wouldn't tell us where because she was afraid of her. We found another girl who took us. This woman didn't have VVF but she said she knew someone else. We drove to this other woman's place, walked through some fields and found her. She came running out and kissed us all but again, not having VVF. It was valentines day and I got an offer of marriage from an old man living in the home. I had to sadly decline. Another girl from the school told us she knew of someone so off we went again. We drove up to a village and asked for this woman. She was out farming so someone had to go get her. We all sat to wait. Whenever we would show up anywhere, the second we step out of the car, benches get pulled out of huts and homes and from anywhere to offer us a seat. As soon as we sit, children come from everywhere. They always kept us entertained while we wait. Fatmata finally came from the fields. She walked into her hut and came out with a follow-up card from the centre. I figured the girl who brought us was confused and just brought us to see an old patient. Fatmata pulled out her card and her old operation report and we noticed that her first surgery for her RVF was back in September of 2007. She was told to come back for another surgery, for her VVF, three months later but due to unrest in the country she never came and never had enough transport money to return. Yeah! Our first woman!

By then it was starting to get late. Bernadette and Francis decided it was best to go back to Makeni to find somewhere to sleep. There were women they had wanted to visit there the next day anyway. More driving... We went to the hotel and it was fully booked. We had to go to the next village to find the next motel. We pulled up and I had such an erie feeling. There was one room left. This crazy room had a bedroom and two sitting rooms. It also had a balcony which the bathroom was built onto. I found out that I would be staying there alone. Oy. Francis and Bernadette didn't want me to stay where they were staying because when they see white skin the price immediately will double or triple or more. So they left and there I was, in my sketch motel room. Joseph, the nice man from reception said he could have someone sleep on my balcony if that would make me feel safer. Um, no thanks. Nothing like a little barricading of the doors to calm my nerves. It ended up being completely fine and I spent the next three nights there.

Tuesday we got up, screened two women who Bernadette found after they had dropped me off the night before and then went in search of a woman who lived in a village far, far away. This road was the worst of all. A whole two hours of it one way. When we finally got to her, it only took seconds of speaking with her to realize she did not have a VVF. Two hours back on the roller coaster ride of a road. After visiting another hospital and not finding anyone, my frustration was rising. We saw one other woman who again, did not have a VVF and by then had to call it a day. Oh, my highlight from Tuesday was getting to see Fatmata, the patient I wrote about in one of my last posts, the young girl who went on the radio with us. It was SO great to see her again! She was so excited to go home and see her family and we had the opportunity to meet them. She said she will have to wait until the start of the next term to return to school but she promised me she would.

Fatmata at her home.

Tuesday night I returned to my sketch room and prayed. With all my frustrations coming from so many different places I needed to be refreshed and even the passion I had for working with VVF women needed to be renewed.

Wednesday we returned to the hospital to follow up on some possible leads. I still don't know where Bernadette would come up with some of these women but we pulled up behind this bus and she said a VVF woman was going to be on the bus. I looked at her in disbelief. Somehow Bernadette had been talking with a woman who was going to bring us a fistula woman from the far north. There she was. Isatu is 17 or 18. She only speaks Fullah, a dialect not many people here can speak. She is very short and you could see the fear in her eyes. She wouldn't make eye contact and just went where she was directed. By the end of our trip, Fatmata, the first women we picked up, had taken her under her wing. She would point her in the right direction and even when we got back here to the center I saw her taking her by the hand leading her into the bathroom to show her how to shower.

At some point Wednesday morning we stopped by a home where we thought another woman was living. Nope. She lived in a village far far away but her sister would come with us to show us the way. Fatmata, the sister, piled into the back of the land rover and off we went. We drove and drove and drove some more. Such beautiful country! Eventually she told us to turn. Oy. This road looked awful. After we got up the first little hill it wasn't so bad. It was only a narrow road wide enough for one car and even then the bushes were still hitting the car. Eventually we reached a village. I thought we were there. Nope. We drove straight through the village and out the other side. I thought it was so random. How often do the people living there really see cars going through? Another village. And another. And another... and then as we left one, the road went from some resemblance of a road with tire tracks to a walking path. It looked like a car never had been that way before. We drove and drove down this small walking path, through more villages until we finally reached our destination. A small village in the interior. When we stepped out of the car, more benches came out of huts and I think there were more kids than adults living in this village. We quickly learned the woman we had come for was even further out at another village but there was no way the car would make it. A cute little boy, probably ten, took off running in jellie shoes, like the ones I had growing up, since no one else wanted to go. We were told it was far. Settling in for our long wait was fine. I was just amused at where I was and what I was in the midst of. Sierra Leone is really a beautiful country. Mountainous. Green. Lush. Three hours later...the jellie shoed boy came back with Isatu. Such a beautiful girl. We examined her and the excoriation from the urine made it impossible for her to wear any sort of pad anymore. She was positive and when we told her we could take her and do her surgery, she cried. She said she didn't have a mother and no way to pay. When we told her it was all free she was happy. Her grandmother was there as well which made for a great send off for her. Back down the long roads and after one flat tire we made it back to the motel. I felt like this was the answer to the prayers I had prayed the night before. True, we did come up with so many false leads, but it made all the difference to Isatu that we never turned back.

As we are coming up on the village.

Isatu in the blue striped shirt with the rest of her village.

Isatu in the middle with her grandmother and sister.

Yesterday we started back to the centre with seven women. Part way home we got a call that someone had thought we were already gone so they had sent a patient to Bernadette's home in Freetown...eight women then. It was a great trip overall. True, frustrating at times but it's a learning process and I'm excited to see where we can go from here and how we can improve our screening trips.

Growing Up

For you did not receive a spirit that makes you a slave again to fear, but you received the Spirit of sonship. And by him we cry, "Abba, Father." Romans 8:15

As I was reading this morning I came across this verse. It turned out to be fitting for my day. Today I went out alone for the first time since I got here. I have been out many times before but always with other people. I had to go to the supermarket and everyone else went to the pool today. I needed some time alone today knowing this week I will be with people all week. I had to psych myself up to go. That may seem funny, and it is, but in all my traveling around West Africa I have never been allowed to venture out alone. With Mercy Ships you always had to go out in groups. In Niger we were so far away from anywhere that to get to town someone would have to drive you and honestly, I wouldn't want to go out alone there anyway. So today I took the poda poda, got stuck in traffic, surprise, walked the last bit there, made it to the supermarket, shopped, exchanged money, and got a taxi home knowing how much it was going to cost. When I sat down the driver said 2000 as I put my foot out the door to get out knowing he was charging me too much. I said no. He said 1500. I said no. He laughed and said ok as I said 1000, knowing that was the right price. He and his friend in the front seat said they were just trying to have a little fun. I told them they were trying to get more money out of me. They said yeah and laughed some more.

Monday I am leaving bright and early to head to Kenema, a province north of here. I am going with Bernadette the screening nurse and Francis, our driver. We are going from Monday to Thursday for a screening trip. I'm excited to go and see more of the country and to see how these trips work. Lately not many fistula women have been coming back with these trips so I'm excited to see why and learn what we can to do improve that. Please pray for me this week. Pray for safety for the trip. Pray we will find women who need help. Pray my eyes will be open to how these trips can be improved. I'm sure I'll have stories to share when I return.

Live

This week we did two live radio shows to get the word out about VVF in this country and to tell about the AWC. On Tuesday we went to the first station. I went with Bernadette, one of the screening nurses, and Fatmata, one of the patients. We arrived at about ten to four. Our on-air time was 4-5pm. I had money in hand and we were ready to go...until we got there and they looked at us and asked what were we doing there. The actual station was an hour away. It would have been nice to have been told that when we set up our date last week in this office. They said they could put us on at 6 instead. Fine. We went to that station and walked up some stairs and down this sketchy hallway. It was dark except for light coming from under the doors we were passing. Another moment where I just think...what am I doing here. At the end of the hallway was the production room. A table with two microphones coming up out of the middle of a padded table and some radio gear. Fatmata is only a girl. Still in school and I was afraid she would be too afraid to talk. I never really saw her talk much on the ward. Put her in front of a microphone...she did great! I was proud of her. Bernadette talked for awhile about VVF and the clinic and all that stuff but Fatmata told her story and she wasn’t afraid. She was even able to talk a bit in Temene, the dialect she speaks at home. It was a call in radio broadcast. Flashing. Flashing is something done a lot here in Sierra Leone. If you want to call someone but not use your minutes, you will flash them. You will call them. Let it ring once and hang up. The person you are calling will see you called and hopefully call you back. The only call-ins we got were flashes. The radio station isn’t going to call you back! So no call-ins that night. That was fine though. The program still lasted an hour and I was so proud for Fatmata!

Yesterday we went to another station. One that reaches the entire country and even a bit into Guinea and Liberia. The frustration with this one came when we went to pay. It was more expensive but I was expecting that. So we paid. We were about to start when the person who was going to run the interview wanted to know how much we were going to pay her. Huh? We already paid. By now we were running late and they were trying to force us on but I know that unless you get money issues sorted before you start something then it just gets messy. Finally the producer came in and said whatever money we give is fine and we need to get on with it. I think that is one of my biggest frustrations here. Money. There is always more and more and more that is expected. There is never an end. If you rent a taxi for a day and take it to the beach, the driver expects you to buy them lunch and after he drops you off to pay more for him to get home and on and on and on...But back to my story... So we gave her a small small amount, and moved on. OY. The show went better than expected. I figured that since we had made our moderator angry that we would have a bad show. It went well though. Again, Fatmata was incredible. Bernadette didn’t come this time. The other screening nurse, Fatmata-a popular name here, came. The callers that called in called from all over the country. From Kenema to Bo to the far reaches of Sierra Leone. It was really encouraging. There was one man who called in after Fatmata, the nurse, had made a comment that after surgery a women can’t have sex for six months. This man called and said that the woman would do whatever the man said. OY, again. For real? After comments like that I look at Fatmata, the patient, and I am so thankful for her. She is headed home tomorrow. I asked her today if she is going back to school and she said yes in a way that made me feel small. I have gotten that feeling from a few of the younger patients here. After this they really know what’s important. Fatmata is headed back to school next week. She is so happy. I don’t know how many times she thanked me today and hugged me. I wish I could see her five, ten, twenty years from now. I have a feeling she will do something big with her life. Driving home from the radio station Fatmata, the patient, got a phone call from home. They had heard her on the radio! She is going home dry, but also a celebrity.

Becoming

I have stood on the top of mountains and gazed at the majestic work of your hands.

Lord, how I desire to to sit in your presence which could only by your grace and mercy be any more beautiful.

Finally

Three of the women after their gladi gladi.

Mama Finnah

During the gladi gladi the women dance twice around the wards.

The wards are set up in a square. To the right is the green ward. To the left is blue ward. Across the way is orange ward. My office door is the one right in the center of the picture.

River #2

Sandra, Me and Bernie

George and Mikey

Every time we pass this hospital I try to get a picture of the sign. You can't read it well at all, but it says: Notice No Money Transaction For Blood Transfusion Please Bring Donors.

A great deal of the population are afraid to donate blood which causes the blood banks to run low. If you need surgery you need to bring people to replenish their stock in case you need some. They won't do many surgeries unless you bring blood donors before you are cut.

HAPPY BIRTHDAY!

Happy Birthday Mom!

Love you!

Susu

I have to admit that I am glad it is Friday. This has been a busy, draining week for me. I wouldn't say that is a bad thing though. I learned a lot and got a lot accomplished and now I'm just tired. Nothing River #2 tomorrow can't help with. I was getting pretty down on myself this week. Patients seem to be being discharged but only a small few are being admitted. We are sending nine home tomorrow and that will give us only a handful of patients left. I was actually taking it personally at the beginning of the week, as random as that sounds. I see part of my job as being bringing the women in. Making sure they hear about us and know how to find help. Only being here a month I am still learning, yes, but I still felt like the low numbers were my fault. As the week went on and I spent one afternoon going around to the different radio stations and getting us slots for next week to go on air, I was starting to relax a bit. I felt like God was really starting to show me that: A. I am not here to do this alone and B. women will come, I just need to be patient. Another reason I was getting frustrated was because we had to cancel the screening trip that was going to go out this week because the screening car needed to be worked on...if anyone out there would like to donate a new vehicle for screening, please get in touch with me. :) There's my plug. The reason I say new is because the roads here are so bad and the places the screening trips need to go are even worse. You don't find many women in the cities. You need to go out into the small villages where the roads are, well...I'm going out on a trip in a week so I'll show you pictures when I get back. Anyway, canceling screening trips slows down the progress we make. I wrote about the advocacy program last week on here and as the women go home I truly believe they are going back and sharing their experiences here in hope of helping their friends. Even today I walked into the ward and there was a cluster of women talking with one of the nurses about a woman back in her village who is wet but she is so scared to come forward. They were all trying to tell this patient who knows the woman how she can go back and encouraging her to come out. The fistula women are the only ones who get one another. No one else can truly understand them.

Today we said goodbye to mama Finnah. This woman was so funny. She has been with us for a few weeks for surgery. She had her day of gladi gladi today and her 'pikin', daughter, came to pick her up today. I wish I had a picture of her hair but she always wrapped it up when a camera came out. She kept it braided in five neat rows. The top of the braids were black but between the braids it was silver. She is well along in her years. The longer she was here, the more silver came out. I finally asked her and yes, she dyes her hair.Her catheter came out a few days ago and she is dry! Whenever I see her she throws her hands up and says, "Tell God tenki!", and we do. Then she looks at me and says, "Shake yo body!", and we do. When she left today I cried. I cried, not because she was leaving, but I cried because of Mariama. Mariama is a seventeen year old patient. Finnah and Mariama both speak susu. Susu is not a dialect spoken by many in the Western Area of Sierra Leone. Finnah spoke susu, krio, and a few other dialects. Mariama only spoke susu. She was crying because the only person she could communicate with was leaving. Finnah went over to where she was sitting and wiped the tears off her face and put her arms around her. It was a great picture of the two of them and the bond they created in the short period of time they spent together.

Radio

Today I took a trip to Freetown. I always enjoy getting out especially when I can take a driver and not have to fight for a taxi or poda poda. Francis drove and Fatmata, one of the screening nurses, came with me. We were on a mission to get on the radio. First stop: SLBC. I have no idea what that stands for. Fatmata seemed to know everyone we met. One woman I was told was famous on the television in Freetown. I thought for a second if I should ask for her autograph but I held back. We found our way up three flights of stair to an office. We were talking with a man about doing a radio show to talk about fistula and get the word out about the AWC. We are scheduled for next Thursday for an "interactive show". I think that means people can call in and ask questions.

Next we hit Star Radio. I'm glad Fatmata was with me because there was no way I would go up to that place alone. We walked through a door which opened up into a small garbage dump then through another sketchy door and up some narrow stairs...good thing I trust my nurses. Star Radio already had a jingle done from before so we just paid for it to continue then got out of there.

Democracy Radio was our final stop. We will do another interactive session with them on Tuesday. I will go along as moral support but due to my lack of Krio I will not be speaking.

I hope the radio will bring in patients. Usually if you just walk outside you hear a radio blasting from somewhere. Sitting in a taxi, you can't get away from it. We are discharging our patients and not as many are coming in. I don't pray for more VVF patients but I pray that those who are wet and need help can find their way here.

Month One in Sierra Leone

Let me take a moment and reflect on the happenings of my first month in Sierra Leone...

• January 3rd I arrived. It’s not hard enough to just land and find your baggage in the midst of hundreds of people, but then having to get on a water taxi to get to the mainland. The adventure had only just begun...
• Was welcomed into an amazing group of people.
• Visited some of the most beautiful beaches around!
• Ate some of the greatest seafood!
• Was crammed and pushed and folded into poda podas and taxis.
• Sat in traffic...
• Sat in traffic...
• Sat in traffic...
• Met some amazing women with fistulas.
• Cried in front of my boss.
• Laughed.
• Stressed.
• Prayed.
• Sent away women in tears knowing where I was sending them was not where they wanted to go but knew there were no other options.
• Led my first staff meeting.
• Wanted a dog.
• Taught my first lecture on hyponatremia.
• Ate African food for lunch five days a week.
• Shook my tumba.
• Danced, and not just at gladi gladi.
• Watched season 1 of Bones.
• Got a job title.
• Questioned what I am doing here.
• Questioned why I ever questioned what I am doing here.
• Saw patients wet.
• Saw patients dry.
• Saw patients somewhere in between.
• Learned about #2 and #3 plugs.
• Slept under a mosquito net every night.
• Woke up at 0230 covered in mosquito bites.
• Breathed.
• Forgot to take my doxi for three days.
• Went to my first management meeting.
• E-mailed the girl in this job before me with tons of questions.
• Made some great friends.
• Took a shower for longer than two minutes in Africa.
• Ate haggis...twice.
• Learned to play carcassonne.
• Saw one monkey.
• Made my first roster.
• Fixed my first roster.
• Still fixing my first roster.
• Witnessed pure joy.
• Witnessed pure heartbrokenness.
• Ate my first lobster.
• Was woken up at 5am to be told there were no more diapers.
• Learning more and more what it really means to trust God.
• Walked into the ward and saw a patient standing directly in front of a large fan holding her shirt above her head.
• Watched an ultrasound.
• Saw brand new babies.
• Bonded with a nurse over scrubbing cabinets.
• Sweat.
• Got filthy from just siting in a car.
• Reunited with friends I had met on a ship last year.
• Joined two Bible studies.
• I think I may have quit one Bible study.
• Sat and talked with patients without using words.
• Heard awful screaming from the labor ward.
• Floated down a river into the ocean.
• Learned very small small krio.

And tomorrow I may be on the radio.